Regionalisation of retinopathy of prematurity (ROP) screening improves compliance with guidelines: an audit of ROP screening in the Northern Region of England
Related Experiment Video
Updated: Jul 30, 2026
Electroretinogram Recording for Infants and Children under Anesthesia to Achieve Optimal Dark Adaptation and International Standards
Published on: September 3, 2020
N G Ziakas1, D G Cottrell, D W Milligan
1Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Insights
A coordinated regional strategy significantly improved screening compliance for retinopathy of prematurity (ROP) in premature infants. This approach enhanced ROP screening rates, particularly for high-risk babies.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Public Health Policy
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- National guidelines exist for ROP screening, but consistent implementation across neonatal intensive care units (NICUs) is challenging.
- A coordinated regional strategy was implemented to address compliance gaps in ROP screening.
Purpose of the Study:
- To evaluate the effectiveness of a coordinated regional strategy in improving national ROP screening guideline compliance.
- To identify specific reasons for non-compliance with ROP screening protocols.
- To assess the impact of the strategy on ROP screening rates in NICUs.
Main Methods:
- Retrospective case note audit of ROP screening in 17 NICUs in Northern England across two periods (1990-1 and 1994).
- Implementation of a regional strategy between the two audit periods.
- Assessment of screening performance against national guidelines and subsidiary standards in the second audit period.
- Identification of factors contributing to missed screenings.
Main Results:
- Overall ROP screening compliance improved from 47% to 73% after the regional strategy implementation.
- Higher compliance rates (93.3%) were observed for higher-risk infants (gestational age ≤ 29 weeks).
- Babies transferred between units, discharged before screening, or not meeting screening criteria were more likely to be missed.
Conclusions:
- A coordinated regional approach can significantly enhance ROP screening uptake, especially for high-risk neonates.
- Recommendations are provided for further improvement in ROP screening guideline adherence.
- The study highlights the broader applicability of regional screening strategies across different conditions and specialties.
Aims:
This project was designed to determine whether a coordinated regional strategy can improve the implementation of national guidelines for screening for retinopathy of prematurity (ROP), and to identify causes for failure of compliance.
Methods:
Retrospective case note audit relating to two periods, 1990-1 and 1994, involving all 17 neonatal intensive care units in the Northern Region of England. Between the two periods, a regional strategy was instituted in an endeavour to improve compliance. Babies born in or admitted to the units during the study periods who were eligible for ROP screening were included. Screening performance was assessed against a standard of 100% compliance with the guidelines. In the second audit period compliance with subsidiary standards was also measured, and reasons for failure were identified.
Results:
Compliance improved from 47% (262/558) in the first audit cycle to 73% (264/360) in the second. Subgroup analysis in this second cycle indicated better compliance (93.3%) in higher risk babies (< or = 29 weeks' gestational age). Babies transferred between units, discharged home before screening, or who failed to qualify for screening on one of the two defined criteria, were more likely to be missed.
Conclusion:
A carefully implemented regional approach to screening resulted in a higher uptake for babies most at risk. Simple recommendations are made to achieve further improvement in compliance with the guidelines. The wider implications for screening in other conditions and in other areas and specialties are highlighted.
